Patients with a compromised ankle/foot resulting from a chronic illness, diabetes mellitus, Charcot joints or even limited mobility or advanced age can be subject to pressure ulcers caused by ischemia, direct trauma and/or repetitive stress. Frequently such patients may suffer from decreased sensation and/or paralysis of the ankle/foot. Various forms of orthotics have been provided as a neuropathic ankle/foot orthoses. Such products have attempted to provide a smooth and efficient pattern of walking with enhanced mobility and functional activities for a patient. At the same time, they attempt to protect the entire foot and ankle structures while reducing loading and shearing forces. Usually such orthotics seek to establish a plantigrade alignment of the deformed foot and ankle structures while utilizing pressure and shear-dissipating materials. Such orthotics are frequently custom made to address relief of, for example, a diabetic foot ulcer in pressure-sensitive areas by establishing support in pressure-tolerant areas of the foot. The foot/ankle can be encompassed within a boot-like structure and a rocker sole can be customized to reduce load bearing forces to the metatarsal heads of the foot. Diabetes is a major factor in lower extremity amputations in the United States and regretfully, diabetics suffer a lack of feeling in the foot, poor circulation, foot deformities, irritation and trauma. Patients who have had diabetes for a number of years can develop neuropathy with a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time.
When an orthotist or a podiatrist determines that an orthotic is necessary to cover the wound and ulcers to prevent a risk of infection, they have frequently had to customize the bottom configuration of the exterior sole to provide appropriate lateral and interior/posterior angular adjustments to accommodate the specific needs of the patient. Frequently a low profile rocker sole is utilized to reduce load-bearing forces to the metatarsal heads of the foot, and the orthotist/podiatrist may have to grind and sand the sole of the orthotic in an attempt to create particularly desired angular adjustments necessary for the particular condition of the patient.